Recommendations for pharmacotherapy for chronic insomnia disorder in adults:

• To decide whether to add pharmacological therapy in adults with chronic insomnia disorder who remain non-responsive to cognitive behavioural therapy for insomnia (CBT-I) alone, a shared decision-making approach should be used to discuss the benefits, harms, and costs of short-term medication use. Improved sleep outcomes, including sleep onset latency and total sleep time, improved global outcomes in the general population and older adults are the advantages of pharmacotherapy.^[1]
• The U.S. Food and Drug Administration (FDA) approved several drugs for insomnia for short-term use (4-5 weeks), and patients should not continue using the drugs for extended periods. The patient should resume using the tools acquired during CBT-I following drug treatment. If the remission does not occur within 7-10 days of treatment, patients should be re-evaluated. Before continuing with drugs, secondary causes of insomnia (e.g., depression, substance misuse, dyspnoea, or restless legs syndrome) should be evaluated.
• Adults should be treated with Suvorexant and Doxepin for sleep maintenance insomnia.
• Eszopiclone, Zolpidem, and Temazepam (15 mg) should be used to treat sleep onset and sleep maintenance insomnia.
• Sleep onset insomnia should be treated with Zaleplon, Triazolam (0.25 mg), and Ramelteon.^[2]

Drugs used for the treatment of chronic insomnia: